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This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

A simple system improvement based on communication between food service staff and floor nurses may improve insulin dosing in hospitalized diabetics.

PHOENIX -- Sometimes simple interventions are the best medicine -- like telling floor nurses that meals are on the way so they can coordinate insulin dosing for hospitalized diabetics.

Patients received prandial insulin on time with significantly greater frequency when food service and nurses coordinated care (50.4% versus 35.5%, P=0.016), according to Shwetha Mallikarjuna, MD, of Southern Illinois University in Carbondale, and colleagues.

Patients receiving coordinated care also had shorter time to receiving insulin after their meal (median time to delivery 20 minutes versus 43 minutes, P=0.006) and significantly more patients received insulin in 30 minutes or less after a meal (P=0.033), Mallikarjuna said at an oral presentation at the meeting of the American Association of Clinical Endocrinologists.

She noted that failure to coordinate meal times with administration of prandial insulin may limit the effectiveness of basal/bolus insulin regimens.

The authors conducted a prospective trial to assess glycemic control and time to insulin delivery among 51 diabetes patients on two floors at the Southern Illinois University School of Medicine Hospital.

On one floor, food service personnel informed unit secretaries when 31 diabetes patients had received food. The secretaries would then inform registered nurses when patients were ready to eat. On the other floor, food was delivered to 20 patients as per usual without any coordination with nurse staff.

The primary endpoint was frequency of on-time administration of insulin lispro, which was defined as delivery within roughly 20 minutes of meal delivery. The secondary endpoints included glycemic control measured through mean capillary blood glucose and categorical distributions of capillary blood glucose, as well as proportion of doses delivered 30 minutes or more after a meal.

Patients were well-matched for diabetes status and sex. Mean patient age was significantly older in the intervention group (69 versus 56, P=0.003). Mean percentage of HbA1c was higher in the control group (9.8% versus 7.9%, P=0.001). Mean percentage of patients using insulin at home was also significantly higher in the control group (70% versus 26%, P=0.001).

On-time delivery of insulin significantly favored the intervention group, though there was no significant difference between groups when comparisons were measured by meal.

A larger proportion of meals were delivered 30 or more minutes after a meal among the control group (56.6% versus 42%, P=0.033), and median time deviance from the meal was significantly greater among those treated on the control floor (43 minutes versus 20 minutes, P=0.006).

Mean capillary blood glucose was significantly higher in patients treated on the control floor (185 mg/dL versus 157 mg/dL, P=0.02), though this difference did not maintain significance after administration of insulin.

"I think future studies should be expanded to more patients, and to more types of setting," Jonathan Leffert, MD, chair and member of the board of directors of the American Association of Clinical Endocrinologists, told MedPage Today.

Leffert, who was not involved in the study, added that the inclusion of patients outside of single-floor settings, such as in an intensive care unit, can "show definitively that you have to give the insulin at the right time to have the right effect."

Mallikarjuna noted that their study was limited by a low sample size and low power. The study was also limited by poor patient matching. She said that a larger follow-up study is ongoing.

The authors declared no relevant financial conflicts.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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